Revenue Integrity Coding Auditor - FT

Position Summary

Seeking a highly skilled and experienced Revenue Integrity Coding Auditor to join our dynamic team. The ideal candidate should possess a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification and a minimum of 3 years of Inpatient and / or Outpatient coding experience.

The Revenue Integrity Coding Auditor will play a crucial role in ensuring accurate coding, MS-DRG assignment, and compliance within our healthcare organization.

Work Schedule

Full-time 40-hour work week - Monday - Friday

Primary Duties

The Revenue Integrity Coding Auditor will be responsible for the following key areas, including but not limited to :

Review Activities :

• Conduct reviews of Clinical Documentation Improvement (CDI) Mismatches.
• Evaluate responses to Late Query submissions.
• Assess Besler Quality Recommendations.
• Examine coding issues related to Medical Necessity and other concerns.
• Investigate MS-DRG Denials.
• Conduct Coding Compliance Research.
• Perform RVU Analysis.
• Review high-risk cases such as Impella, TCAR, Aveir DR.
• Handle Rebill Requests.
• Address Discharge Not Final Billed Reports.
• Provide continued support for Charge review.

Collaboration :

• Work closely with Providers, Clinical, Coding, and CDI team members.
• Respond to coding questions and collaborate with CDI QA team on DRG reconciliation.
• Collaborate with the Director of HIM / Coding / Billing regarding coding quality and education recommendations.

Auditing and Reporting :

• Perform random and focus-selected medical records review for accurate coding and MS-DRG assignment.
• Summarize audit findings and provide feedback to the Director.
• Keep detailed records of audits, results, recommendations, and follow-up actions.

Training and Education :

• Assist in the training of new coding team members.
• Contribute to educational activities for all coding team members.
• Provide education to providers on coding updates, documentation standards, and summary reviews.

External Audits :

Review and respond to third-party coding audits / reviews.

Benefits :

The successful candidate will contribute to the organization's overall efficiency, resulting in benefits such as :

• Increased efficiency in coding processes.
• Lowering Days Not Final Billed (DNFB).
• Decreasing Accounts Receivable (AR) days.
• Providing research support for coding and RVU-related questions.
• Improving cash flow.
• Note : This job description is subject to change as the needs of the organization evolve.*

Qualifications

Qualifications / Specifications

• Education : High School diploma or equivalent required.
• Licensure / Certification : Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification required
• Experience : Minimum of three years of experience in medical coding with ICD-10 and CPT coding systems required. Detail-oriented and experienced coding professional with a passion for ensuring accuracy and compliance.
14 days ago